Arthritis is very common in older cats. One study showed that approximately 90% of cats over the age of 12 have some level of arthritis present, and it has been found in cats as young as 2-3 years of age in some circumstances. Arthritis is not a reversible condition once it develops, and it always progresses over time. Also, the symptoms of arthritis in cats are very subtle, and are often missed by their owners. Arthritis tends to be most painful after rest, so you may see that your cat is stiff getting up after a nap, etc. Arthritis in cats, just like in people, is also more pronounced in cold or wet weather. Many people see that their older pet is just getting up slower or not moving around well, and just attribute it to “old age.” In addition, you may see that your cat is having a harder time jumping up to heights that he or she used to bound to with ease. Another common sign is reduced grooming behavior, resulting in matting of the coat around the back, sides, and tail area. The spine is a common area for arthritis to develop in cats, and this results in pain when the cat reaches around to groom these areas. Because of the pain involved, the cat will often just choose not to groom themselves appropriately any more, resulting in matting of the coat. It is important to recognize that these signs are caused by pain related to arthritis in most cases. Treatment is aimed at controlling the pain, reducing the progression of the arthritis, improving mobility, and maintaining overall health.
The recommendations that I am going to make are generally needed life-long for arthritis. As arthritis progresses, the treatment recommendations for a specific patient will change. Arthritis treatment includes 4 parts, with a 5th option.
One important additional note. If your pet has symptoms that seem consistent with arthritis, but the symptoms come on suddenly, progress rapidly (over days to weeks, rather than months to years), are associated with loss of function of one or more legs, or are accompanied by any other systemic signs (loss of appetite, vomiting, weight loss, coughing, difficulty breathing, excessive thirst or urination, etc.), then this may not be arthritis, or there may be an additional problem present along with the arthritis. Your pet needs to be evaluated by a veterinarian when beginning a medical treatment regimen for arthritis. Blood/urine tests, and possibly x-rays are strongly advised to rule out other medical problems. A particularly common problem in older cats that can cause weakness is hypokalemia. This condition results from the depletion of an ion in the body called potassium. It is a spontaneous onset disorder in many older cats that results in significant muscle weakness that could be confused with arthritis pain. There is a simple blood test that can help to diagnose this disorder, and it is treatable with an oral potassium supplement.
1) Increased exercise/weight control:
Exercise helps keep the joints more mobile and helps to maintain muscle strength and mass (so that the muscles can help to support the arthritic joints). The less active a cat is, the more stiff he/she gets. Exercise should be performed on a regular basis.
Getting a cat to exercise can be a difficult task, in many cases. Remember that any increase in activity can be of benefit. Some cats will chase a feather on the end of a string, or chase a thrown wadded up piece of paper. In many cases, getting a cat to exercise is futile.
Another factor is weight control. Cats that are arthritic tend to be less active. This tends to lead to weight gain, which is harder on the joints and tends to make then want to move around even less, so they gain more weight…a dangerous cycle. In addition, we now know that there are 2 kinds of fat that develop in the body…peripheral fat (on the outside of the ribcage and other external areas) and abdominal fat (which is strictly within the abdomen). We now know that abdominal fat not only is hard on arthritic joints by increasing the weight that they must carry, but also that it is actually a chemically active organ. Abdominal fat produces chemicals called cytokines, many of which are the chemicals that the body uses in creating the chemical reaction which results in inflammation and pain. Over 20 of these chemicals have been identified, so far. Therefore, abdominal fat actually “feeds” the inflammation and pain of arthritis. Arthritic cats often benefit from being on a low calorie diet and getting low calorie treats (or no treats), in moderation, to help keep their weight controlled.
Chondroprotective agents like glucosamine and chondroitin have been used for many years in dogs. We are now finding tha5t they are even more effective for arthritis control in cats than they are in dogs.
These agents are not drugs. They are essentially nutritional supplements (“nutraceuticals”) for the joint. They are very safe to use, even in the presence of other medical problems. They do not control pain directly, but they do help to maintain the health of the joint cartilage, which results in reduced pain and probably slows down the progression of arthritis. The end result is a more comfortable joint. They do not start working as soon as you give them, like pain medications do. These products are meant to be used long-term, to help maintain the joint health as much as possible. Don’t be discouraged if you do not see an immediate effect. The effect may not be evident, even though it is helping the joint. There are 2 main types of chondroprotective agents:
Preferred product: Feline Joint Care (Cheyenne West Animal Hospital)
Glucosamine is one of the primary building blocks of cartilage. Oral glucosamine supplements are very popular, and are beneficial for the joints. Glucosamine is often combined with other products (chondroitin, MSM, creatine, manganese, vitamin C, etc.) to enhance its effect.
There are many products, both prescription and over-the-counter, and some foods that contain these components. Other good products include Joint Care, Cosequin, Dasuquin, Glycoflex, GLC1000, and many more.
As glucosamine has become more commonly used, there has been an explosion of products available, in all price ranges.
A word of caution: Glucosamine is not a drug, and is not regulated by the FDA. It is considered a nutritional supplement, and therefore has much more lenient guidelines regarding its manufacturing. In addition, companies do not have to prove that their product is consistent in its formula, or that their product is in a form that can be absorbed or used properly by the body. Many of the over-the-counter products are substandard in their formulation. The good news is that these products are rarely, if ever, harmful. The bad news is that, even though a product is much cheaper, it still may not be as beneficial for your pet as a more reputable brand. Expensive over-the-counter products are not always going to be better quality, but the cheaper the product, the higher the likelihood that it is not going to be as effective.
That being said, it is better to use a less expensive over-the-counter product, than using nothing at all. Some is better than none.
ADEQUAN: Arthritis does to joint fluid what your car would do to oil if you never changed the oil…it causes a breakdown of viscosity. Adequan is an injectable chondroprotective agent. It works on the joint fluid, rather than the joint cartilage. It helps to decrease some of the ongoing damage that makes the joint fluid less viscous. It is a very safe product. It is given by your veterinarian as an intramuscular injection twice weekly for a course of 8 injections. This is the course recommended by the manufacturer, and I find that these cats often benefit from getting an additional “maintenance” injection every 2-4 weeks, thereafter.
The advantage is that it can help reduce the progression of arthritis, and is very safe.
The disadvantage is that it has to be given by injection. However, we can teach to administer the injections at home in a safe and effective manner.
Conclusion: Glucosamine is beneficial to cats with joint problems and arthritis at any stage, from very early to very advanced. Adequan is also a great additional treatment. It can be used by itself, or can be combined with glucosamine. Both of these are safe and effective, and can be combined with any other form of therapy.
A special note on diet: Some diets advertise that they contain glucosamine, chondroitin, and/or Omega-3 fatty acids. This claim is usually true, but the important factor is whether or not the diet contains an amount that is enough to have the desired positive effect on the joints. A particular diet that claims to have these ingredients should be critically evaluated as to the amount that is present.
One diet that does have the appropriate amount of glucosamine and Omega-3 fatty acids is a prescription diet from Hill’s Called Prescription diet j/d (which stands for “joint diet”). This diet contains an appropriate amount of these ingredients, so can be fed in place of using these supplements.
3) Omega-3 fatty acids:
Dose: 180mg of EPA per 10 pounds of body weight, once daily
Preferred product: EFAC Natural Support for Joint Health
Fatty acid supplements, primarily Omega-3 fatty acids, are beneficial for allergies and other conditions. These products have been used for a long time in skin conditions, and there are many products available on the market. Our knowledge of the effectiveness of these products has changed over the last few years, and we are now using 5-6 times the dosage that we used to use. This higher dosage is beneficial for inflammatory conditions such as allergies, arthritis, inflammation of the organs, and other areas. Many older products have a label dose that is far too low to be significantly beneficial. There is an enhanced form of fatty acids that is in the veterinary product “EFAC,” which stands for esterified fatty acid complex. This is the most absorbable form of fatty acids available. There is a specific product available for arthritis in cats.
Omega-3 fatty acids, primarily EPA and DHA, are the primary active oils. They are known to be protective against some of the negative effects of inflammation, and (at the proper dosage) have some anti-inflammatory action themselves. There are other fatty acid supplements out there, the ideal one is one that is has a fish oil source.
The dose is based on the level of EPA (Eicosapentanoic acid) in the product.
Dose: 180mg EPA per 10 pounds of body weight, once daily. This can be adjusted up or down a bit, depending upon the strength of the product that you are using.
There are many of these products, both prescription and over-the-counter, and some foods that contain these components. There are a number of good veterinary products available, but the label dose is not always the therapeutic dose.
As Omega-3 fatty acids have become more popular, there has been an explosion of products available, in all price ranges.
A word of caution…an Omega-3 fatty acid supplement is not a drug, and is not regulated by the FDA. It is considered a nutritional supplement, and therefore has much more lenient guidelines regarding its manufacturing. In addition, companies do not have to prove that their product consistently has the amount of active ingredient that the product has on the label. Nor do they have to prove that it is in a form that can be absorbed or used by the body. Many of the over-the-counter products do not have the right amount, or it is in a form that the body can’t absorb or use. Other than this concern, the products are not harmful, and don’t contain a significant amount of calories.
That being said, I would rather have patients on an over-the-counter product, than on nothing at all.
4) Pain medication:
Arthritis is painful. That’s why cats are stiff, have lameness, or refuse to groom themselves. Cats tolerate chronic pain very well, though, and generally don’t cry or show other signs, so some people are under the misconception that it doesn’t hurt. Cats with arthritis almost always benefit from some level of pain medication. However, the pain medications that are safe for use in cats are very limited. Most non-steroidal anti-inflammatories (NSAiDs) are not recommended for cats, or if used, are used in very low or infrequent doses. In addition, some pain medications, like Tylenol and other acetaminophen-containing products are deadly to cats!
NSAiDs are better avoided in cats unless it is felt that their use far outweighs the potential risks of negative side effects. These drugs will be discussed later.
Pain medications available that are NOT NSAiDs:
* “DURALACTIN: This is a prescription drug made for animals, and is an anti-inflammatory, but is not an NSAiD. This drug has a different mechanism of anti-inflammatory action. It is safe to use in an animal that has active liver or kidney disease, and is easy on the stomach. There is a specific form of this medication that is made for cats. This drug is probably not as strong as a true NSAiD, but is safer, especially in the presence of other disease conditions. It comes in a liquid form
Advantages: Very safe. Good for use if other medical problems are present.
Disadvantages: Moderately expensive and not as strong pain medication as a true NSAiD.
TRAMADOL: This is a prescription pain medication that is not an anti-inflammatory. It is similar to narcotic drugs, but not quite as strong as the narcotics, but does not have the side effects of the narcotics. It is not a controlled substance, because it is not addictive, like the narcotics.
Advantages: Very few side effects. Best when used as an adjunct to an anti-inflammatory drug (like Duralactin) for more advanced arthritis. It can be used if other medical problems are present, in most cases.
Disadvantages: It comes naturally in a tablet form. It can be made into a liquid suspension, but experience indicates that it has an unpleasant taste.
GABAPENTIN: This is a drug that is used for neuropathic pain in many circumstances, but in cats can be a safe and effective medication for chronic pain, such as with arthritis. This is a prescription medication. In almost all circumstances, this medication must be compounded into a form (liquid or capsule) that can be accurately dosed in cats. The prescription medication for humans comes in a liquid form as well, but be aware that the liquid that is made for humans should not be used in cats, because of the artificial sweetener (xylitol) that is used in it. This sweetener is not safe for cats.
NARCOTICS: Primarily Buprenorphine, which is a potent prescription pain medication. This is a controlled substance that comes in injectable form only. However, when it is administered orally, it is absorbed into the system directly through the oral tissues. Very good pain control, but potential side effects include constipation and urine retention. Best when used as an adjunct to an anti-inflammatory drug for more advanced arthritis. Better than tramadol for pain.
Advantages: Very good pain control in cats.
Disadvantages: Expensive, potential side effects; controlled substance.
STEROIDS: Primarily prednisone. These are very potent anti-inflammatory drugs. They are stronger than NSAiDs. The problem is that at the dose required to control arthritis pain, it has wide-ranging side effects on the body, including the liver, kidneys, bones, muscles, stomach, and intestines. It can cause high blood pressure, decreased healing ability, weight gain, stomach ulcers, and suppression of the immune system.
Advantages: Very good anti-inflammatory drug, inexpensive.
Disadvantages: Many side effects and can actually speed up the progression of arthritis. Only used when nothing else seems to be effective, usually as a last resort.
Non-Steroidal Anti-inflammatory Drugs (NSAiDs):
Whenever a pet is on an NSAiD, he/she needs to be monitored for side effects. Symptoms can include: excessive drooling, panting, excessive thirst, vomiting (especially if the vomit contains blood), loss of appetite, or black/tarry stools. Any NSAiD has the potential to cause progressive kidney disease in cats, in addition to the other potential side effects.
There are many NSAIDs available now. Here is a brief description of some of them. This is not intended to be a complete list of all available drugs, since new drugs are regularly introduced to the marketplace, nor is it a complete list of the possible side effects of each drug mentioned. Additional literature with more complete information is available, upon request.
ASPIRIN: This was the original NSAiD. It is a mild to moderately good pain medication, is inexpensive, and is non-prescription. It is not nearly as strong as the prescription medications and much more likely to produce gastritis/stomach ulcers or have adverse affects on the kidneys.
If aspirin is used, it is typically recommended to give1/2 to 1 baby aspirin twice WEEKLY (one dose every 3-4 days). Any more than this can cause problems. It is also wise to avoid “enteric coated” aspirin products. They are not harmful, but they often pass through the system too quickly, and are not absorbed completely in pets, so they don’t help as much.
IBUPROFEN (“ADVIL”): Don’t use this!!
NAPROXEN (“ALEVE”): Don’t use this!!
ACETAMINOPHEN (“TYLENOL”): Don’t use this!! This drug is deadly to cats.
PIROXICAM (“FELDENE”): This is a prescription NSAiD. It has good pain control and is an inexpensive drug. This can be used when we want more pain control, but cost is a concern. The problem is that this drug is more likely to cause gastritis, stomach ulcers or kidney problems than most of the other available prescription drugs. The drug is only available in capsule form, so if we ever use it in cats, it must be compounded into a liquid form by a compounding pharmacy.
Advantages: It is relatively inexpensive, and has good pain control.
Disadvantages: It has a higher risk of side effects, is off-label use in cats, must be formulated through a compounding pharmacy, and recently has become more difficult to find as many manufacturers are discontinuing the drug.
*MELOXICAM (“METACAM“): This is a prescription drug made for animals. It is similar to piroxicam, but is an updated, slightly safer version. It comes in a honey-flavored liquid that can be mixed with the food.
Advantages: Good pain control, once daily administration, easy to give because it is already formulated into a liquid, reduced side effects.
Disadvantages: More expensive than the drugs listed above. In addition, there has been shown to be significant risk of kidney disease with prolonged use of this drug in cats.
*CARPROFEN (“RIMADYL”): This is a prescription drug made for animals.
This drug is often given as a single injection for post-operative pain, but is not for long-term use in arthritic cats.
5) Alternative therapies – acupuncture:
Acupuncture is an ancient oriental technique that most people have heard of. There are many potential reasons why this therapy can benefit patients with arthritis, however, it is difficult or even impossible to describe in “western” terminology. This is a therapy that has been used effectively for thousands of years in people and animals, and has significant benefits, especially for chronic pain conditions.
Acupuncture can be performed in our office by Dr. Lopez. In addition, there are holistic veterinarians in Las Vegas that we can refer you to that are specifically trained in acupuncture and other alternative therapies, such as chiropractic. Please call our office for more details.
In early to mid-range arthritis, I recommend:
– Glucosamine (with or without chondroitin)
– Fatty acid supplement
– +/- Adequan
When arthritis is more advanced, I recommend the above plus:
If more severe pain is present, or the symptoms are non-responsive to medications, recommend the addition of tramadol or gabapentin. Buprenorphine is used in the most severe or refractory cases.
Non-steroidal antiinflammatories (NSAiDs) are only used if the benefit of using the particular medication outweighs the potential risks. This is rarely used.
1) NEVER USE A STEROID AND AN NSAiD AT THE SAME TIME.
2) NEVER USE 2 DIFFERENT NSAIDs AT THE SAME TIME.
The above 2 circumstances can result in severe and potentially lethal side effects. If we change from one NSAiD to another or change from a steroid to an NSAiD (or vice versa), then the pet must be off of the current drug for 3-7 days before starting the drug that we are changing to. We will usually give Tramadol (which can safely be given with any of the other above drugs) to control pain during this “wash-out” period.